Notification of strongyloidiasis in Australia

Tuesday, 2 June, 2015

Infection with the parasitic worm, Strongyloides stercoralis is lifelong, unless treated. This cunning parasite lives in the small intestine of humans and produces infective larvae inside the body. These autoinfective larvae reinfect the unfortunate host from the inside. The original infection is due to infective larvae that have developed in faeces deposited on the ground (just like hookworm). But unlike hookworm, when the old worms die, for Strongyloides, the effete mother worms have been replaced by generations of young and vigorous daughters. Once infected, always infected!

The good news is that strongyloidiasis is easily cured - ivermectin is highly effective.

In the Medical Journal of Australia this week, myself, and colleagues, Adrian Miller and Wendy Page put forward a case to make infection with S. stercoralis a notifiable disease and ask for it to be included in Australia's National Notifiable Diseases Surveillance Scheme (NNDSS). Listing strongyloidiasis on the NNDSS would provide the information needed to control and eliminate this parasite from Australia.

Strongyloidiasis occurs largely in marginalised groups: members of rural and remote Aboriginal communities, refugees, and in soldiers and peace-keepers who have served in endemic areas. The occasional tourist also is infected. In Aboriginal communities prevalence seems to be about 20% (Maunsey et al 2014; Shield et al 2015) while a recent study showed about 11% of Vietnam veterans carried the parasite (Rahmanian et al 2015).

Strongyloidiasis can cause acute disease, chronic disease with low level morbidity or rarely severe disease with death. The latter typically occurs when people with chronic strongyloidiasis are started on corticosteroids (Buonfrate et al 2013).

Accurate data on the incidence and location of strongyloidiasis in Australia can inform a national control and eradication program and may also improve management of individual patients, particularly if a strongyloides register is implemented.